Rheumatologists working in every practice setting face a number of challenges that can seem insurmountable. How do you cost-effectively manage administrative burdens? How do you establish an efficient and effective approach to capturing quality metrics? How do you maintain the critical elements of the care you provide, such as diagnostic musculoskeletal ultrasound and patient access to medications?
Through the work of rheumatology advocates working for and with the ACR and through initiatives with coalition partners, such as the American Medical Association (AMA), the College has made headway with payers and on Capitol Hill to make rheumatology practice more effective for and accessible to members and the patients they serve, according to ACR Government Affairs Committee Chair Angus Worthing, MD, FACR, FACP. One example of the power ACR advocacy efforts have had recently on daily practice: the College’s success with advocating for UnitedHealthCare to continue to reimburse rheumatologists for consultations, after proposing to stop payments for these important services, Dr. Worthing shares.
Here’s a look at several key practice areas in which the ACR’s advocacy efforts have been successful and how practices are reaping the benefits.
Reducing Administrative Burdens
Administrative burdens are widespread in medical practices today on a number of fronts, including electronic medical record use, quality reporting, coding and prior authorization requirements. Reducing the administrative burdens placed on rheumatology practices has long been an ACR priority.
The ACR Committee on Rheumatologic Care (CORC) has been very active in addressing this issue, according to CORC Chair Colin Edgerton, MD, FACP, RhMSUS. “A major issue has been step edit therapy and formulary tiering requiring prior authorizations. CORC has developed a position statement advocating for meaningful and less burdensome cost-mitigation strategies. The ACR Insurance Subcommittee [ISC] communicates these positions directly to insurance companies—responding to member concerns as they arise,” Dr. Edgerton says.
For example, Dr. Edgerton shares that the ISC has been quick to respond to his practice’s concerns regarding burdensome prior authorization programs. “The ISC has scheduled calls and sent letters with significant impact, and ACR staff and volunteers are easy to contact and very responsive,” he acknowledges.
Last year, advocacy efforts by the ACR and other groups led to the passage of step therapy laws in five states and successful advances with federal step therapy legislation in Congress. The ACR, along with coalition partners including the AMA, has successfully advocated for reforms to prior authorization to streamline the process and make it more transparent, and to increase patients’ access to medicines, Dr. Worthing explains. The ACR has also helped create a consensus statement to share the rheumatology perspective on improving the prior authorization process.